Our monthly update on the project to modernise payment and prior approvals as part of the eDental programme, covering:
- eDental payment update – June 2018
- ePrior Approval
- eOrtho payment and approval
eDental payment update
As all practices are now enabled for eDental submission of payment claims, and all existing practice management system (PMS) suppliers are now accredited for eDental payments.
Any queries regarding eDental should now be directed to Customer Services on 0131 275 6300 or email firstname.lastname@example.org
There are still a number of claims that are being unnecessarily rejected. This can lead to a delay in the processing of these claims through to payment.
These rejections primarily occur when practices are providing observations when they are not required, for example:
- Patient failed to return (PFTR)
- Referral details
- Domiciliary visit details
- Registration status
- Claim resubmissions
- CHI number
- Prior approval date
- Special needs (item 45c) detail
Our eDental guidance has more information on observations.
If you receive a Midas claim rejection, the claim the reply letter relates to must be resubmitted via eDental with the necessary amendment, if payment is still being requested. We cannot amend rejected claims sent via eDental.
Our eDental guidance has more information on error codes.
The live early adopter pilot phase continues with web form users, and we have received 74 prior approval requests to date. We have approved 56 of these requests, with others at varying stages of the process; a number of which are awaiting evidence such as x-rays or models.
Top ePrior Approval Tip
When evidence has been submitted using the attachment upload facility, or sent in as physical evidence, you must advise us of what has been sent, for example physical evidence or electronic radiographs. This action is carried out by updating the prior approval request on your PMS or, if appropriate, the webform.
To update once evidence has been submitted, you must also go back into the web form and complete the ‘Submission’ tab of the request, where a new area called ‘Supplementary Information’ will now be visible. You must select if either attachments have been uploaded, and/or any physical evidence has been submitted.
Once complete, you should resubmit the request electronically from the webform to us, within 28 days. If you do not, you will receive a reminder to do so, after which you have 14 days before the case is closed.
Read our guidance for Prior Approval.
In addition, some early changes identified to PARS (our internal prior approval review system) have already been developed and passed user acceptance testing. Implementation of these changes to live PARS has now been made.
One PMS supplier, Systems for Dentists (SFD), has passed the accreditation phase for ePrior Approval. We have also made changes at our side in relation to ePrior Approval, which have now been released. SFD have now commenced their beta testing which will run for a few weeks before full roll out.
Beta testing is essentially a short period of time where a few early adopter practices move ahead with the changes and provide feedback for the PMS suppliers. As a result of the feedback, a PMS supplier may make improvements and then roll this out the all other sites.
It is important to note that each supplier must undertake fit for purpose testing and e-prior approval accreditation testing before they can roll the changes out to their customers. We now have responses from the vast majority of PMS suppliers in relation to their anticipated development and delivery dates for electronic Prior Approval.
Get more information on progress on our supplier pages.
For Carestream users, where the limit is reached in treatment planning, the user will be prompted to send in a prior approval claim. From this prompt, the user will be able to access the web form portal from within R4+.
In our most recent update from Carestream, they indicated they are still in the design phase but intend to release their plans very soon. This will be done on the Exchange, which is Carestream’s online customer community.
All prior approval requests must be submitted electronically from 1 October 2018 and paper requests will no longer be accepted beyond that date.
If your PMS supplier is not ready in time for 1 October 2018, you will need a web form account in order to submit Prior Approval requests.
The anticipated lead time is around 2 weeks. In this event, you will be required to complete some paperwork before we can turnaround your user account.
eOrtho payment and approval
We are on target with our development and testing for Orthodontic payment and prior approval. The changes are being developed and released in three phases for us to complete user acceptance testing. Phase one and two have now been released for us to begin testing. The third phase is due in early July.
The first PMS Supplier Fit for Purpose testing is planned to commence around August 2018, with accreditation due to commence in September 2018.
One of the orthodontic specialist PMS suppliers, AssisOrtho has now provided timescales, and two of the general PMS suppliers (SFD and SOE) have committed to the development.
We are still awaiting confirmation from other PMS suppliers, as we need to understand their intention.
Check our PMS supplier pages for the latest progress.
You are reminded that paper submissions for Orthodontic Prior Approval requests and payments will no longer be accepted after 1 January 2019.